Did you ever dream of becoming an astronaut, a pilot, a parent, a dentist, a doctor, a diver or a Formula 1 driver? It was these fantastical, panicky thoughts that came rushing through on D-Day (Diagnosis Day). Illogical yet perfectly human - my mind was firing off in all directions with the news. A state of want, of loss, of abandonment came rushing in. Amongst the ‘what-might-be’’ was ‘what about children?’ even if they weren’t on my radar at the time
Many Irish people don’t go through a lot of thinking about how they’re going to have children; we move through adulthood, perhaps meeting someone, setting up home together and then children follow. But if children are not an option without assistance (gay/lesbian/low fertility) or there are issues, it is then we wake up. We learn about AMH, the sperm count, choosing a donor, counting cycles, the disappointment of missing a cycle, of getting your period, or the heart-break of miscarriage. Or not. Many people have decided they want to be childfree with others who just didn’t have the opportunity or it was never the right time.
• If you’re on them, you’ll have to come off Disease Modifying Therapies (DMTs) and other medications in plenty of time before becoming pregnant. Do not use them when breast-feeding. Aubagio, Avonex, Betaseron, Copaxone, Fampyra, Gilenya , Novantrone, Plegridy, Rebif, Tecfidera or Tysabri are not safe in pregnancy. Talk to your neurologist.
• There is risk of foetal abnormality from drugs and medication. If you’re taking DMTs, use contraception if your having sex.
• There may be some effects on sperm production and count from DMTs and other medications.
• If you’re considering fertility treatment, you need to learn all about the side effects and speak with your neurologist before you start. The ‘stims’ may have an effect on your immune system in ways you don’t realise; the last thing you want is a relapse when in the throes of the fertility journey.
• Other issues for women include muscle weakening of the pelvic area and/or loss of mobility or function, all things that can exacerbate bladder and bowel problems during pregnancy (but are a normal part of being pregnant because of the growing foetus).
For anyone considering having a child or adding more to your family, talk about fertility with your partner, your friends who have MS and children and family. Have your fertility tested; with knowledge you can make informed choices and make decisions based on what’s best for you as well as your partner and your family. Woman or man, do the right things by your body (exercise, a good diet, healthy relationship) and you’ll be giving yourself the best chance at enjoying your own life while trying to create a new one.
The great news is there is absolutely no evidence that a woman’s fertility is affected by MS but there is lots of evidence that confirms pregnancy can be a very good, normal experience. Many women discover the positive biochemical effects of pregnancy (the immune system is suppressed to allow for the foetus to grow inside her body, the increase in good-feeling naturally boosted corticosteroids) and the other natural boosts from the changes in her body means the majority of women with MS have a normal pregnancy. But if there is a lot of disease activity or if there is loss of function, decisions need more time and planning.
Although the issues are the same for MSers as for other pregnant women keep in mind the additional aspects of having MS. There is a risk of relapses after the birth - as the immune system comes back to normal but there is no evidence that there is long-term disability because of pregnancy. As with the relapse rates, the life-changes that come with having a new-born in our lives is something we can never be prepared for. BUT do build your support networks, have people prepped and ask for help when you need it.
Next week I’ll be going through other aspects of fertility and pregnancy particularly the first five weeks of life with a new baby.
- MS Trust Pregnancy and Parenthood
- Multiple sclerosis and pregnancy in the 'treatment era'. Vukusic S, Marignier R Nature Reviews Neurology
- Fertility, pregnancy and childbirth in patients with multiple sclerosis: impact of disease-modifying drugs’ Amato MP, Portaccio E. CNS Drugs